Cardiovascular Risk Estimation Research Articles

Cardiovascular risk prediction - now and the future

Current cardiovascular risk estimation systems that estimate 10-year risk based on cohort studies starting at around age 40 have probably reached their limits based on current methods. The challenges are to develop new systems that will permit personalised risk estimation earlier in life with better estimates of true lifetime risk and likely treatment benefits. We outline approaches to address these issues.

Ten-year cardiovascular risk estimation in type 2 diabetes in Europe using the novel SCORE2-Diabetes model

Ten-year cardiovascular risk estimation in type 2 diabetes in Europe using the novel SCORE2-Diabetes model

Editorial comments: focus on cardiovascular risk estimation and prevention.

Editorial comments: focus on cardiovascular risk estimation and prevention.

Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography.

Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation.

Cardiovascular risk associated with chronic treatment of paliperidone, olanzapine, risperidone and aripiprazole

IntroductionWeight gain, QT interval prolongation, and dyslipidemias associated with the chronic use of some antipsychotic medications can explain a higher prevalence of cardiovascular risk in these psychiatric population. The D’Agostino Index include some factors such as age, total cholesterol, high-density lipoproteins, systolic blood pressure increased, antihypertensive treatment, smoking, and diabetes, to estimate an individual’s risk (low, moderate or severe) of developing a cardiovascular event through a period of 10 years or throughout the patient’s lifetime.ObjectivesTo compare the degree of cardiovascular risk using the D’Agostino Index, among different antipsychotic medications.MethodsAn estimation of cardiovascular risk (low, moderate, or high) was performed with the D´Agostino index in a sample of 144 patients (82 men and 62 women) mean age 45,2 +/- 10.13. All patients were treated for at least one year at a therapeutic dose and adhered to their treatment regimen correctly. Subjects with some relevant pre-existing unstable heart disease were excluded. All patients previously provided informed consent and were of legal age. Clinical data on medical history, concomitant medications, and risk factors were collected. A completed physical exam, waist circumference, lab sample, a lifestyle scale, and an evaluation of vital signs in accordance with European Society of Hypertension were evaluated. Statistical analysis was carried out using the statistical software SPSS version 26.0. A significance level α=0.05 was considered throughout the study.ResultsThe four most consumed antipsychotics were risperidone 9.72% (n=14), paliperidone 25.7% (n=37), olanzapine 14.6% (n=21), and aripiprazole 34.7% (n=50). Descriptively, it was observed that the drugs most associated with moderate or high risks were paliperidone (37.8%) and olanzapine (33.3%), risperidone (28.6 %). Aripiprazol (22%) was the less associated compound with moderate/high cardiovascular risk.ConclusionsSubjects treated with olanzapine and paliperidone showed a higher association with cardiovascular risk. Predicting cardiovascular risk could provide individual benefits by enabling lifestyle modifications, pharmacological treatment changes, or closer monitoring to reduce cardiovascular risk.Disclosure of InterestA. Montejo Grant / Research support from: This study has been funded by the Instituto de Salud Carlos III (ISCIII) through the project PI19/1596 and co-funded by the European Union., C. Bermejo: None Declared, J. Matías: None Declared, T. Martín: None Declared, J. Matías-Polo: None Declared, Y. Santana: None Declared, J. López-López: None Declared, R. de Alarcón: None Declared, J. Acosta: None Declared

Association of Periodontitis with Ambulatory Blood Pressure, Salt Intake, and Neutrophil-Lymphocyte Ratio in High-Risk Hypertensive Patients

<i>Objective</i>: Periodontitis and cardiovascular disease are prevalent entities that often coexist, with a common pro-inflammatory pathway. The objective of this study was to evaluate the association between periodontitis and cardiovascular pro-inflammatory parameters rarely considered within risk factors. <i>Methods</i>: Forty-three participants aged between 38-82 years were examined. An association between mean probing depth (MPD), mean attachment loss (MAL), bleeding on probing (BOP), and periodontal inflamed surface area (PISA) was correlated with the following cardiovascular disease factors and inflammatory promoters: neutrophil-to-lymphocyte ratio (NLR), 24h ambulatory blood pressure, global cardiovascular risk, daily salt intake, night-time systolic blood pressure (nSBP), and pulse wave velocity (PWV). A two-way ANOVA and multiple comparison tests were performed using SPSS statistics software. <i>Results</i>: A highly significant correlation (p<0.05) was found between BOP, MPD, and MAL with high salt intake, global cardiovascular risk estimation, nSBP, and PISA. Also, significantly statistical correlation (p<0.05) was found between BOP, NLR, and PWV while PISA was only associated with NLR. Logistic regression analysis identified absolute values of nSBP, salt intake and NLR as possible independent contributors to the increase in the <i>log</i> odds of developing BOP. <i>Conclusions</i>: Several periodontal disease parameters are linked to cardiovascular risk factors such as hypertension, neutrophil-to-lymphocyte ratio, daily salt intake and night-time systolic blood pressure.

Universal screening for early detection of chronic autoimmune, metabolic and cardiovascular diseases in the general population using capillary blood (UNISCREEN): low-risk interventional, single-centre, pilot study protocol

IntroductionChronic autoimmune (type 1 diabetes and coeliac disease) and metabolic/cardiovascular (type 2 diabetes, dyslipidaemia, hypertension) diseases are highly prevalent across all age ranges representing a major public health burden. Universal...

European Lipid Guidelines and Cardiovascular Risk Estimation: Current Status and Future Challenges.

Genetic, experimental, epidemiologic, and clinical data support the causal role of elevated levels of low-density lipoprotein cholesterol (LDL-C) in atherosclerosis and cardiovascular disease (CVD). The recommendations of the 2019 European guidelines are based on the concept of differential CV risk, which in turn defines the LDL-C goals that should be achieved. The 2019 ESC/EAS guidelines for dyslipidaemia use the Systematic COronary Risk Evaluation (SCORE) model to assess CV risk, which provides a 10-year risk of fatal CV event. The SCORE model has recently been updated to reflect current rates of cardiovascular disease in Europe. The new SCORE2 model provides estimates of the 10-year risk of fatal and non-fatal CVD events in people aged 40-69 years, thus improving the identification of individuals at higher risk of a CVD event. However, as in the SCORE age is the main determinant of risk, young people have a relatively low estimated 10-year risk of a CV event even with high levels of one or more causal risk factors. Individuals with familial hypercholesterolaemia, who have elevated LDL-C levels from birth and have a high risk of premature CVD, are one example. The concept of cumulative LDL exposure is thus becoming increasingly important. This is also supported by Mendelian randomisation studies showing that carrying genetic variants associated with lower LDL-C levels reduces CV risk. These observations have introduced the concept of "cholesterol-years", which takes into account both LDL-C levels and time of exposure. It is crucial that future European guidelines pay more attention to this point.

IoT system development for heart rhythm monitoring and cardiovascular risk estimation

The research focuses on addressing the global issue of cardiovascular diseases. The key variable under consideration for predicting cardiovascular diseases is heart rate variability (HRV). Leveraging the widespread adoption of IoT in various applications, particularly in the health sector, the study proposes the design and implementation of an IoT system for HRV monitoring. The research unfolded in four methodological phases: exploration and selection of technologies, definition of the IoT architecture, development of the prototype, and verification of its functionality. The implemented IoT system adheres to the conventional 4-layer IoT architecture: capture, storage, analysis, and visualization. Heart rate data is periodically acquired using a heart rate sensor and an Arduino-compatible board. The storage layer employs a non-relational database to store the captured data. The analysis layer extracts metrics related to HRV (High: RR <750 ms, Moderate: RR 750–900 ms, Low: RR >900 ms) by applying and delivering quantitative results from clustering algorithms such as machine learning models to evaluate data distribution. Risk levels indicate specific patient metrics. Thus, a 75-year-old patient exhibits an average HR of 75.56, Avg. RR of 795.42, falling into Cluster 1 with a risk value of 1.0. Similar detailed metrics and risk stratifications are presented for patients aged 68, 46, 37, and 18, demonstrating the system's robustness and efficacy in assessing cardiovascular risk. The visualization layer enables real-time observation of physiological variables, risk metrics, and results from data analytics models. The distinctive features of the results lie in the portability advantages of the IoT system, utilizing free hardware and software tools. This facilitates easy replication and utilization of the proposed system in medical campaigns, specifically for the early detection of cardiac conditions. The portable IoT system, leveraging free tools, enhances predictive capabilities for early cardiovascular risk detection globally

Food intake, plasma copeptin and cardiovascular risk in patients with type 2 diabetes: A cross-sectional analysis

Background and aimIncreased consumption of ultra-processed foods has been linked to both mortality and cardiovascular risk. Copeptin levels may serve as potential risk markers for cardiovascular death and events. This cross-sectional analysis seeks to assess the potential correlation between the intake of ultra-processed foods and copeptin levels in outpatients diagnosed with type 2 diabetes, based on estimates of cardiovascular risk. Methods and resultsOutpatients underwent clinical and nutritional assessments. Dietary information was gathered using a validated quantitative food frequency questionnaire, and the consumption of all foods, beverages, and food products was assessed according to the NOVA food classification system. Fasting plasma-EDTA samples were collected and preserved at −80 °C. Plasma copeptin measurements were analyzed using an enzyme-linked immunosorbent assay based on the competition principle. Participants were categorized into two groups: high risk and very high risk, based on cardiovascular risk calculated by the HEARTS calculator. A total of 190 participants were included in the evaluation, with an average age of 60 ± 9 years, glycated hemoglobin of 8.4 ± 1.4%, and a diabetes duration of 11 (5–19) years. Patients at a very high cardiovascular risk exhibited higher plasma copeptin levels compared to those at high cardiovascular risk. Notably, 92.1% of patients reported consuming more than 10% of total energy intake from ultra-processed foods, although this proportion did not differ between the two groups. ConclusionThis patient sample reported elevated consumption of ultra-processed foods; nevertheless, the correlation between ultra-processed foods and plasma copeptin has not been substantiated.

Novel Therapies for Lipoprotein(a): Update in Cardiovascular Risk Estimation and Treatment.

Lipoprotein(a) is an important causal risk factor for cardiovascular disease but currently no available medication effectively reduces lipoprotein(a). This review discusses recent findings regarding lipoprotein(a) as a causal risk factor and therapeutic target in cardiovascular disease, it reviews current clinical recommendations, and summarizes new lipoprotein(a) lowering drugs. Epidemiological and genetic studies have established lipoprotein(a) as a causal risk factor for cardiovascular disease and mortality. Guidelines worldwide now recommend lipoprotein(a) to be measured once in a lifetime, to offer patients with high lipoprotein(a) lifestyle advise and initiate other cardiovascular medications. Clinical trials including antisense oligonucleotides, small interfering RNAs, and an oral lipoprotein(a) inhibitor have shown great effect on lowering lipoprotein(a) with reductions up to 106%, without any major adverse effects. Recent clinical phase 1 and 2 trials show encouraging results and ongoing phase 3 trials will hopefully result in the introduction of specific lipoprotein(a) lowering drugs to lower the risk of cardiovascular disease.

A comparative study of cardiovascular risk stratification methods in type 1 diabetes mellitus patients

The Steno Diabetes Center Copenhagen developed the Steno T1 Risk Engine (ST1RE) to predict cardiovascular events, encompassing fatal and nonfatal ischemic heart disease, ischemic stroke, heart failure, and peripheral arterial disease in type 1 diabetes mellitus(T1DM).The current study investigated the agreement between ST1RE and the Brazilian Society for Endocrinology and Metabology (SBEM) classification. Participants were included in the study if diagnosed with T1DM and had at least one outpatient visit in 2021. Patients with established cardiovascular disease and chronic kidney disease on dialysis were excluded. Clinical parameters were obtained from medical records, such as age, body mass index (BMI), blood pressure, physical activity, current smoking, microvascular target organ damage, levels of low-density lipoprotein cholesterol, creatinine, glycated hemoglobin (HbA1c), and albuminuria.Overall, 92 patients (38 males and 53 females) with an age median (P25; P75) of 33 years (25.5;42.5), BMI of 24.8 + 4.1 kg/m2, and duration of diabetes (mean ± SD) of 23.4 + 9.5 years were evaluated. There were no differences considering the gender for most analyzed variables, but a higher proportion of women exhibited microvascular complications such as microalbuminuria, macroalbuminuria, and retinopathy. Our results show a weak agreement in the 10-year cardiovascular risk estimation between SBEM and ST1RE classifications. According to SBEM criteria, 72.8% of patients were considered high-risk, while only 15.2% of patients received the same classification using ST1RE. The dissimilarities between these two classifications were also evident when age and gender factors were compared. While 60% of patients under 35 years were classified as high risk according to SBEM criteria, only 1.8% received this stratification risk in the ST1RE classification.The results indicate a low agreement between the 10-year cardiovascular event risk classification by SBEM and the classification by ST1RE for type 1 diabetes patients without established cardiovascular disease.

Cardiovascular Risk Assessment Using Updated WHO/International Society of Hypertension Risk Prediction Charts and Atherosclerotic Cardiovascular Disease Risk Score in Residents of Amreli District

Introduction: India is one of the countries the World Health Organization (WHO) has recognized as having the majority of lifestyle-related illnesses in the near future. The highest incidence of CVD are found on the Indian subcontinent. Objectives:To assess the cardiovascular risk among adults aged >40 years using the updated WHO/ISH risk prediction charts and ASCVD risk score and to compare baseline cardiovascular risk estimation by both risk scores. Method: This cross-sectional study was done among 228 individuals aged 40–74 years of urban and rural areas. A semi-structured interviewer administered questionnaire was developed. The data was collected in Epicollect 5 mobile application and analyzed using Jamovi software. Results:The mean age of the study participants was 56.54 ±0.73 years. CVD high risk was signiicantly higher in males as compared to females (P<0.05). The ASCVD risk score classiied (38.2%), of the participants as high-risk, whereas the lab-based and non lab-based versions of WHO/ISH risk prediction classiied less than 10% as high risk. There was moderate agreement between the lab-based and non lab-based versions of the WHO/ISH risk prediction (Kappa-0.724, p-0 .000), fair between ASCVD risk score and non lab-based versions of the WHO/ISH (Kappa-0.310, p-0.000). The agreement between, ASCVD risk score and lab-based version of WHO/ISH risk predictor was fair (Kappa-0.309, p-0 .000). Conclusion: In current study, it was observed that one-third of the participants had a high risk of CVD events based on the ASCVD risk score, and a smaller number of participants were found to be at high risk according to the WHO/ISH risk chart. So we need to implement this risk scores predictors of CVD events for identify the high risk individual and their further management. Keywords: Atherosclerotic Cardiovascular Disease Risk Score, Cardiovascular Disease, WHO/International Society of Hypertension

Assessing the short-term effects of PM2.5 and O3 on cardiovascular mortality using high-resolution exposure: a time-stratified case cross-over study in Southwestern China.

Air pollution is a major risk factor of cardiovascular disease (CVD). To date, limited studies have estimated the effects of ambient air pollution on CVD mortality using high-resolution exposure assessment, which might fail to capture the spatial variation in exposure and introduce bias in results. Besides, the three-year action plan (TYAP, 2018-2020) was released; thus, the constitution and health effect of air pollutants may have changed. In this study, we estimated the short-term effect exposed to particulate matters with parameter less than 2.5µm (PM2.5) and ozone (O3) with 0.05° × 0.05° resolution on CVD mortality and measured the influence of TYAP in the associations. We used random forest models with spatial weight matrices to attain high-resolution pollutant concentrations and conditional Poisson regression to assess the relationship between air pollution and cardiovascular mortality. With an increase of 10µg/m3 in PM2.5 and O3 during 2018-2021 in the Sichuan Basin (SCB), CVD mortality increased 1.0134 (95% CI 1.0102, 1.0166) and 1.0083 (95% CI 1.0060, 1.0107), respectively, using high-resolution air pollutant concentration, comparing to 1.0070 (95% CI 1.0052, 1.0087) and 1.0057 (95% CI 1.0037, 1.0078) using data from air quality monitoring stations (AQMs). After TYAP, the relative risk (RR) due to PM2.5 rose up to 1.0149 (95% CI 1.0054, 1.0243), and the RR due to O3 rose up to 1.0089 (95% CI 1.0030, 1.0148) in Sichuan Province. We found significantly positive association of cardiovascular mortality and air pollution in Sichuan Province. And using high-resolution exposure would be more accurate to estimate the effect of air pollution on CVD. After TYAP, the cardiovascular mortality risk estimation due to PM2.5 decreased in elderly in SCB, and the risk due to O3 increased in Sichuan Province.

Multiple Cardiac Biomarkers to Improve Prediction of Cardiovascular Events: Findings from the Generation Scotland Scottish Family Health Study.

Many studies have investigated whether single cardiac biomarkers improve cardiovascular risk prediction for primary prevention but whether a combined approach could further improve risk prediction is unclear. We aimed to test a sex-specific, combined cardiac biomarker approach for cardiovascular risk prediction. In the Generation Scotland Scottish Family Health Study, N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor-15 (GDF-15), cardiac troponin I (cTnI), cardiac troponin T (cTnT), and C-reactive protein (CRP) were measured in stored serum using automated immunoassays. Sex-specific Cox models that included SCORE2 risk factors evaluated addition of single and combined biomarkers for prediction of major adverse cardiovascular events (MACE). Combined biomarker models were compared to a baseline model that included SCORE2 risk factors. The study population comprised 18 383 individuals (58.9% women, median age of 48 years [25th-75th percentile, 35-58 years]). During the median follow up of 11.6 (25th-75th percentile, 10.8-13.0) years, MACE occurred in 942 (5.1%) individuals. The greatest increase in discrimination with addition of individual biomarkers to the base model was for women GDF-15 and for men NT-proBNP (change in c-index: + 0.010 for women and +0.005 for men). For women, combined biomarker models that included GDF-15 and NT-proBNP (+0.012) or GDF-15 and cTnI (+0.013), but not CRP or cTnT, further improved discrimination. For men, combined biomarker models that included NT-proBNP and GDF-15 (+0.007), NT-proBNP and cTnI (+0.006), or NT-proBNP and CRP (+0.008), but not cTnT, further improved discrimination. A combined biomarker approach, particularly the use of GDF-15, NT-proBNP and cTnI, further refined cardiovascular risk estimates.

Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk population

Background The use of a single abnormal finding on electrocardiography (ECG) is not recommended for stratifying the risk of cardiovascular (CV) events in low-risk general populations because of its low discriminative power. However, the value of a scoring system containing multiple abnormal ECG findings for predicting CV death has not been sufficiently evaluated. Methods In a prospective community-based cohort study, 8417 participants without atherosclerotic CV diseases (ASCVDs) and any related symptoms were followed for 18 years. The standard 12-lead ECGs were recorded at baseline and the ECG findings were categorized using the Minnesota code classification. CV deaths were defined as death from myocardial infarction (MI), chronic ischemic heart disease, heart failure, fatal arrhythmia, cerebrovascular event, pulmonary thromboembolism, peripheral vascular disease and sudden cardiac arrest and identified using the Korean National Statistical Office (KOSTAT) database. Results In a multivariate Cox proportional hazard (CPH) model, major and minor ST-T wave abnormalities, atrial fibrillation (AF), Q waves in the anterior leads, the lack of Q waves in the posterior leads, high amplitudes of the left and right precordial leads, left axis deviation and sinus tachycardia were associated with higher risks of CV deaths. The ECG score consisted of these findings showed modest predictive values represented by C-statistics that ranged from 0.632 to 760 during the follow-up and performed better in the early follow-up period. The ECG score independently predicted CV death after adjustment for relevant covariates in a multivariate model, and improved the predictive performance of the 10-year ASCVD risk estimator and a model of conventional risk factors including age, diabetes and current smoking. The combined ECG score (Harrell’s C-index: 0.852, 95% confidence interval [CI], 0.828–0.876) composed of the ECG score and the conventional risk factors outperformed the 10-year ASCVD risk estimator (Harrell’s C-index: 0.806; 95% CI, 0.780–0.833) and the model of the conventional risk factors (Harrell’s C-index: 0.841, 95% CI, 0.817–0.865) and exhibited an excellent goodness of fit between the predicted and observed probabilities of CV death. Conclusions The ECG score could be useful to predict CV death independently and may add value to the conventional CV risk estimators regarding the risk stratification of CV death in asymptomatic low-risk general populations.

Ten year follow-up study regarding treatment compliance and cardiovascular events in young first diagnosed and never treated hypertensives of a European Society of Hypertension Excellence Center

Abstract Background Early onset arterial hypertension (AH) is associated with a considerably increased risk for cardiovascular (CV) disease if left untreated. Treatment is based on the estimation of CV risk in each hypertensive patient. The compliance of each individual hypertensive in proposed life style changes and medical treatment is paramount. We aimed to investigate the compliance in medical treatment and we set as primary endpoint of the study the incidence of any CV events [CV death, acute myocardial infarction (AMI), stroke] and all-cause death of a cohort of young first diagnosed and never treated hypertensives of a European Society of Hypertension (ESH) Excellence Center. Population and Methods: We studied 220 young, non-diabetic (<50 years old) first diagnosed and never treated hypertensive patients (42+7 years, 70% males, 41% smokers, BMI=29+5, 24-h ambulatory blood pressure monitoring (ABPM) =142+10/91+9 mmHg, LDL=133+36 mg/dl, 49% had >1 HMOD) visiting our ESH Excellence Center (2004-2021). All patients were apparently healthy with no co-morbidities. In each patient, the presence of hypertension mediated organ damage (HMOD) was evaluated at baseline (aortic stiffness, left ventricular hypertrophy, coronary flow reserve, diastolic dysfunction. The cohort was re-evaluated at 10+4 years post-medical treatment initiation regarding compliance as well as the primary endpoint of the study. Results 191/220 (87%) young hypertensives (at baseline, 42+7 years, 70% males, 40% smokers, BMI=29.5, 24-h ABPM=142+10/91+9 mmHg, LDL=133+36 mg/dl, 49% had>1 HMOD) participated in the follow-up study while 29 (13%) patients were lost. We found that 17/191 (9%) quit medical treatment. Home or office BP was confirmed as controlled (<140/90 mmHg) in 151/191 (79%) patients. Regarding CV events, 7/191 (4%) hypertensive patients (at baseline, 44+4 years, 86% males, 71% smokers, BMI= 30+4, 24-h ABPM=142+12/89+10 mmHg, LDL=175+33 mg/dl, 87% had>1 HMOD) had an acute myocardial infarction (AMI) at 6+4 years post-treatment initiation while 1/191 (0.5%) patient died due to lung cancer. Hypertensive patients with CV events differed regarding increased LDL levels at baseline (168+35 vs.131+36, p=0.007), more smokers (p=0.04) and HMOD >1 (p=0.02) compared to the rest of the young hypertensive population. Conclusions Compliance regarding medical treatment was sustained in 9/10 young hypertensive patients during the 10-year follow-up. Just 4% of the population, smokers with increased LDL and HMOD>1, suffered an AMI despite compliance in medical antihypertensive treatment. Subsequently, treating AH in young people needs both life style changes (quit smoking) and medical treatment (hypertension plus hyperlipidemia) in order to prevent future CV events.CV events in young hypertensives

Pulse wave velocity has an additive prognostic value to SCORE2 in apparently healthy subjects at 6 years of follow up

Abstract Backround/Aim: Arterial stiffness is involved in the clinical course of atherogenesis. The purpose of this study was to investigate whether altered arterial wall properties of confers predictively and additively to estimation of cardiovascular risk. Methods Pulse wave velocity carotid-femoral (PWVc-f), the gold standard method to assess arterial stiffness, was measured non-invasively by Complior device. Increased PWV(c-f), especially above 10 m/s, indicates increased arterial stiffness. We measured baseline PWV(c-f) in 747 apparently healthy subjects (51.99±13.41 years old, 43.8% males), without established cardiovascular disease and calculated SCORE2 in each subject according to ESC guidelines.We prospectively monitored the occurrence of major cardiovascular events (MACEs-death, myocardial infarction, stroke) during a 6-year follow-up period using electronic records and clinic visits. Results Fifty-seven MACEs were documented during follow-up. In univariate analysis, subjects with increased PWV were found to exert greater risk for MACEs (hazard ratio (HR):1.12, 95%CI: 1.09-1.15, p<0.001). PWV remained a significant predictor for MACEs in a model including sex, age, hyperlipidemia, diabetes, hypertension, current smoking, family history of coronary artery disease and treatment with ACEi/ARBs or lipid lowering agents after using backward elimination (HR:1.13; 95% CI: 1.08-1.18, p<0.001). PWV was an independent and additive predictor of outcome when added in a model including solely SCORE2 (HR:1.10; 95% CI: 1.07-1.14,p<0.001; Chi-square change:20.08, p<0.001; C-statistic increase from 0.592 to 0.685) and also in a model encompassing risk factors not included in SCORE2, namely diabetes (HR:1.07; 95% CI: 1.04-1.11,p<0.001; Chi-square change: 43.12, p<0.001; C-statistic increase from 0.613 to 0.698). The HR of PWV for the prediction of MACE remained similar in subjects younger or older than the age of 50 years (p>0.05). Conclusion Arterial stiffness is an independent and additive predictor to conventional risk factors and SCORE2 for adverse outcome at 6 years follow-up.

Estimation of 10-year cardiovascular risk among adult population in western Nepal using nonlaboratory-based WHO/ISH chart, 2023: A cross-sectional study.

Noncommunicable diseases have emerged as a major cause of morbidity and mortality worldwide among which the majority of the deaths are caused by cardiovascular diseases. Estimating the risk of cardiovascular diseases helps eliminate the risk factors and prevent developing cardiovascular diseases in the future. The World Health Organization in association with the International Society of Hypertension has developed risk charts for the estimation of 10-year risk for cardiovascular diseases. This study aimed to estimate 10-year cardiovascular risk in the Nepalese population using nonlaboratory-based charts. A hospital-based cross-sectional study was conducted among 314 adults aged 40-74 years visiting the outpatient departments of Shishuwa Hospital in western Nepal. Systematic random sampling was used to select the participants. Questionnaire-guided short interviews, physical examination, and anthropometric measurements were done. The χ 2 test was used to test the significance and a p < 0.05 was considered statistically significant. As per the risk estimation charts, high cardiovascular risk (20%-30%) was seen in 6.1% of total participants and moderate cardiovascular risk (10%-20%) was found in 29% of participants. The moderate-high risk was significantly higher among male participants compared to females (p < 0.01). Of all the participants, 22.0% were current smokers, 17.2% were alcohol users, 61.1% were hypertensive, and 35.7% were diabetics. Smoking tobacco, alcohol use, and hypertension were significantly more prevalent among the male participants. (p < 0.01) Adults in the 50-59 years age group had a significantly high prevalence of hypertension (p < 0.01), diabetes (p = 0.02), and alcohol abuse (p = 0.01). This study shows high cardiovascular risk among adult population in western Nepal. The 10-year cardiovascular risk score and risk factors were significantly higher among males than females. There seems to be a prompt necessity of health promotion interventions to reduce cardiovascular risk factors and prevent the burden of cardiovascular diseases in Nepal.

Association of accelerometry-based and self-reported physical activity with cardiovascular risk in South African children

The burden of non-communicable diseases is increasing, with risk factors emerging early in life. Physical activity reduces cardiovascular risk, but limited evidence exists for children from lower-income countries and mostly relies on self-reported methods that might be inaccurate and biased. We aimed to compare self-reported and accelerometer-measured physical activity in relation to cardiovascular risk markers in children from underserved communities in South Africa. We analysed cross-sectional data from 594 children aged 8 to 13. Physical activity was measured via accelerometry and the Physical Activity Questionnaire for Older Children (PAQ-C). Correlation analyses and linear regression models examined the relationship between accelerometer-measured and self-reported physical activity and their association with cardiovascular risk markers (body mass index, blood pressure, blood lipid profile and glycated haemoglobin). Results show a positive but weak correlation between PAQ-C scores and accelerometer-measured moderate-to-vigorous physical activity (MVPA). MVPA was inversely associated with body mass index, whilst sedentary behaviour correlated positively with lipid levels. PAQ-C scores were inversely associated with systolic blood pressure. The comparison of self-reported and accelerometer-measured physical activity in children from Gqeberha, South Africa, revealed inconsistencies in their correlation and association with cardiovascular risk markers. Accelerometry provided a more accurate cardiovascular risk estimation than PAQ-C, although associations were weak. Further, longitudinal studies should investigate the predictive power of both methodologies. These findings inform researchers and public health practitioners in the choice of method for physical activity appraisal beyond practical considerations, especially when combined with cardiovascular risk and in lower-income settings. Significance: We explore two widely used methods to assess physical activity levels in children. By comparing both methods, we expose inconsistencies in their correlation and association with cardiovascular risk markers. These data can guide researchers and public health practitioners in the use of one method beyond practical considerations. Whilst this work focuses on children from marginalised areas of South Africa, the issues explored are of relevance to other lower-income settings. Open data set: https://doi.org/10.5281/zenodo.7217145